Talk Doesn’t Pay, So Psychiatry Turns to Drugs (NYT)

[somone]

http://www.nytimes.com/2011/03/06/health/policy/06doctors.html

Talk Doesn’t Pay, So Psychiatry Turns to Drugs
By GARDINER HARRIS

DOYLESTOWN, Pa. — Alone with his psychiatrist, the patient confided that his newborn had serious health problems, his distraught wife was screaming at him and he had started drinking again. With his life and second marriage falling apart, the man said he needed help. But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”

Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy, the form of psychiatry popularized by Sigmund Freud that dominated the profession for decades. Instead, he prescribes medication, usually after a brief consultation with each patient. So Dr. Levin sent the man away with a referral to a less costly therapist and a personal crisis unexplored and unresolved.

Medicine is rapidly changing in the United States from a cottage industry to one dominated by large hospital groups and corporations, but the new efficiencies can be accompanied by a telling loss of intimacy between doctors and patients. And no specialty has suffered this loss more profoundly than psychiatry.

Trained as a traditional psychiatrist at Michael Reese Hospital, a sprawling Chicago medical center that has since closed, Dr. Levin, 68, first established a private practice in 1972, when talk therapy was in its heyday. Then, like many psychiatrists, he treated 50 to 60 patients in once- or twice-weekly talk-therapy sessions of 45 minutes each. Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. Then, he knew his patients’ inner lives better than he knew his wife’s; now, he often cannot remember their names...

[physioex]

1. I am well aware of this....

The nature of the industry thanks to the insurance companies has become all about turnovers. In another words, performace is measured by how fast you can go from the current patient to the next at any given time and quality goes out the door.

[Ilsa]

2. My insurance informed us that they will only pay for a limited amount of

the low dosage of certain medications. They see them as initial doses. He can get higher doses paid for, but that means I'll be splitting tablets. Oh well.

Yeah, our insurance companies are dictating treatments. Fuck them.

[Celebration]

6. Blame the drug companies for this

They don't charge much more per tablet for the higher doses. I would do the same thing as an insurance company, or if I were paying for my own medication.

[auntsue]

3. I needed meds and talk therapy, as a social worker I knew

that each had its place as a treatmant option. My insurance would pay for one OR the other. Psychiatrists basically prescribe and talk therapy is done by MSW (masters in social work) or MFC (marriage and family counselor) or Phd is Psych. I could not make the underlings at my HMO understand, so I took the meds and read up and tried to counsel myself. If you have a kid with mental health needs you need a psychiatrist and a therapist and/or behaviorist - try to get the bean counters to understand this.

[Ilsa]

7. I do, a child with autism.

I've fought battles with my insurance. They even ignored the special rider for speech therapy my spouse's employer added to alleviate some of the burden of his therapy. Every year, I have to contact HR to get them to call UHC to get them to reimburse us.

I'm amazed that they wouldn't cover at least a couple of visits with your psychiatrist for medication updates. Would it work out better if you paid for the psychiatrist visits on your own and let insurance cover the counseling?

[xchrom]

4. As some one who has wanted to undergo analysis

For many years - you can't afford it and few psychiatrist are
Trained in it.

It's not therapy.

[jp11]

5. Excellent story.

I felt bad for the doctor at first then read how he basically turned into an assembly line to push drugs, granted patients want to get fixed 'now' but his own motivation to 'maintain his lifestyle' along with the harsh attitude in his assemply line to collect and charge doesn't inspire much sympathy.

It is sad that the insurance companies along with the drug companies push this as our fix instead of trying to help people get over many of these issues without drugs or in a way that could ween them off the drugs. Instead the solution seems to be get fixed with drugs you'll take for the rest of your life, of course there are side effects but that isn't important cause you didn't have to waste time talking to someone and drug companies get paid.

[Kennah]

8. Is shock therapy about to make a comeback?

[CindyLou]

9. Mental Health

Jesus i hope not! I went through a psychosis last year and was hospitalized for one month. I prefer the meds over shock therapy anyday.

[Sgent]

11. Comeback?

It never left. It is still used frequently in treatment resistant depression and bipolar. Its also very effective.

That being said, its a bit different than it was 30 years ago. Patient is put under anesthesia, given very high strength muscle relaxers so there is no jerking etc. Its done inpatient at many hospitals.

[noneisthenumber]

10. Great article. It seems to me that...

a loss of intimacy is a growing problem in all areas of modern life. The pace of life accelerates, technology replaces humanity, real personal connections between people dwindle: it's really very sad.